People with bladder cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for bladder cancer.
The prognosis is different for each type of bladder cancer. Papillary urothelial carcinomas of the bladder have the best prognosis. Small cell carcinoma tends to have a poorer prognosis.
The stage of bladder cancer is an important prognostic factor. The lower the stage, the more favourable the prognosis. The deeper the cancer has grown into the bladder wall or surrounding tissue, the less favourable the prognosis. Cancer that has spread to the lymph nodes or to other areas of the body has a poorer prognosis.
Stage 0a has the most favourable prognosis. The prognosis for stage 0is is not as favourable as stage 0a because there is a greater risk that carcinoma in situ will eventually develop into a cancer that invades the muscle.
The prognosis for stage I (especially high-grade tumours) is not as favourable as stage 0a.
Bladder cancer can come back, or recur. Recurrent bladder cancer still has a good prognosis because it rarely grows deeply into the bladder wall.
The lower the grade, the more favourable the prognosis. High-grade tumours have a greater risk of disease progression and a less favourable prognosis. Doctors usually describe bladder tumours as high grade or low grade, but many pathologists still use a 3-point or 4-point grading system.
People with a single small tumour have the lowest risk that cancer will come back, or recur. They have a more favourable prognosis.
People with smaller tumours have a more favourable prognosis than people with large tumours.
Recurrent bladder cancer means that the cancer has come back after it has been treated. Of all cancers, bladder cancer has the highest recurrence rate. About 70% of people with bladder cancer will have a recurrence. Treatment helps lower the risk of recurrence.
Time to recurrence is also an important prognostic factor. Tumours that recur within the first 2 years after diagnosis and successful treatment are more aggressive and have a higher chance of growing and spreading.
Performance status is the measure of how well a person is able to perform ordinary tasks and carry out daily activities. People with a poor performance status have a less favourable prognosis than people with a good or fair performance status.